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目的总结细菌感染致坏死性肺炎患儿的临床特点,提高诊治水平。方法回顾性分析2008年1月至2013年7月深圳市儿童医院收治的16例影像学诊断符合坏死性肺炎患儿的临床资料、影像学特点、病原学、治疗及预后。结果男9例,女7例,年龄4个月至6岁[平均(1.7±1.5)岁],15例既往健康。16例均咳嗽、有痰、发热,体温(39.4±0.5)℃,热程6~31(16.4±8.0)d,治疗1~21(9.1±5.1)d后热退。住院时间11~53(21.4±11.2)d。WBC<5×109/L者3例,(5~12)×109/L者3例,>12×109/L者10例,平均(30.20±12.3)×109/L。中性粒细胞比例0.73±0.12。16例CRP增高,33.3~231.0(115.1±73.3)mg/L。病程3~18(11.4±4.0)d时胸部X线平片或CT可发现肺部囊性病灶。右肺叶受累多见,均未见纵隔肺门淋巴结肿大。胸腔积液或血培养明确病原7例,肺炎链球菌2例,金黄色葡萄球菌2例,铜绿假单胞菌3例(其中1例肺炎支原体抗体1∶1280);其中3例与痰培养病原一致。13例使用万古霉素和(或)亚胺培南治疗;5例加用阿奇霉素或红霉素。9例行胸腔闭式引流,其中1例行胸腔脓肿切开引流术及纤维板剥离术;均未行肺叶切除术。所有病例出院后6个月内随访X线平片或CT,提示肺部病灶大部分吸收或基本吸收。结论儿童坏死性肺炎热程及病程长、血象高、影像学表现较重,但及时抗感染治疗远期预后较好。肺炎链球菌、金黄色葡萄球菌是较为常见的病原,铜绿假单胞菌值得关注。
Objective To summarize the clinical features of children with necrotizing pneumonia caused by bacterial infection and to improve the diagnosis and treatment. Methods The clinical data, imaging characteristics, etiology, treatment and prognosis of 16 children with necrotizing pneumonia who underwent imaging diagnosis from January 2008 to July 2013 in Shenzhen Children’s Hospital were analyzed retrospectively. Results There were 9 males and 7 females, ranging in age from 4 months to 6 years [mean (1.7 ± 1.5) years], and 15 were previously healthy. Sixteen patients had cough, phlegm and fever, body temperature (39.4 ± 0.5) ℃, and temperature ranged from 6 to 31 (16.4 ± 8.0) days, respectively. Length of stay 11 ~ 53 (21.4 ± 11.2) d. There were 3 cases with WBC <5 × 109 / L, 3 cases with (5 ~ 12) × 109 / L, and 10 cases with> 12 × 109 / L with an average of (30.20 ± 12.3) × 109 / L. The neutrophil ratio was 0.73 ± 0.12 in 16 cases, and the CRP increased from 33.3 to 231.0 (115.1 ± 73.3) mg / L. The duration of 3 ~ 18 (11.4 ± 4.0) d chest X-ray or CT can be found cystic lesions of the lungs. Right lung involvement more common, no mediastinal hilar lymph nodes. Pleural effusion or blood culture clear pathogen in 7 cases, 2 cases of Streptococcus pneumoniae, Staphylococcus aureus in 2 cases, 3 cases of Pseudomonas aeruginosa (1 cases of Mycoplasma pneumoniae antibody 1: 1280); 3 cases and sputum culture pathogen Consistent. Thirteen patients were treated with vancomycin and / or imipenem; five patients were given azithromycin or erythromycin. 9 cases of closed thoracic drainage, including 1 case of pleural abscess incision and drainage and fibrebral dissection; no lobectomy. All patients were followed up 6 months after discharge X-ray or CT, suggesting that most of the lung lesions absorbed or absorbed. Conclusion Childhood necrotizing pneumonia has long-term fever course, high blood level and severe imaging findings, but the long-term prognosis of timely anti-infective therapy is better. Streptococcus pneumoniae, Staphylococcus aureus is the more common pathogen, Pseudomonas aeruginosa deserve attention.